No-reflow phenomenon during percutaneous transluminal coronary angioplasty

Society of cardiac angiography and interventions: Suggested management of the no‐reflow phenomenon in the cardiac catheterization laboratory

“…The observation of reduced TIMI flow with a column of contrast in the vessel distal to the target lesion that does not rapidly clear is sufficient to make this diagnosis [1,2,6]. The original target lesion appears patent without evidence of dissection, thrombus, spasm, or high-grade residual stenosis.…”

“…No-reflow as a cardiac phenomenon was originally identified in experimental models of acute myocardial infarction and described as the failure to restore normal myocardial blood flow despite subsequent removal of the coronary arterial obstruction, attributable to microvascular damage related to irreversible ischemic changes and local edema. It has been recognized for over a decade clinically [6,7] as an uncommon (0.6 -2.0%) complication of PCI [1,2,6]. It occurs frequently following thrombolytic or mechanical reperfusion for acute myocardial infarction and in the setting of unstable angina [3,7,8].…”

No-Reflow Phenomenon

“…After thrombolytic therapy, the patient will experience chest pain and ST-segment elevation and may have hemodynamic deterioration. 82 New Q waves may appear, 83 and some of those patients may be diagnosed as having infarct extensions. In a study by Komamura et al, 84 9 patients with acute anterior myocardial infarction, early reperfusion, and probable no reflow were studied.…”

Intracoronary adenosine administered during rotational atherectomy of complex lesions in native coronary arteries reduces the incidence of no-reflow phenomenon

“…No-reflow has been shown to complicate management of patients presenting with acute myocardial infarction who receive thrombolytic therapy or undergo percutaneous revascularization [3][4][5]. This phenomenon manifests as reduced coronary flow (TIMI Ͻ 1) as detected by angiography without concomitant target artery dissection, spasm, thrombus formation, or severe residual stenosis obstructing coronary flow.…”